Neonatal Network
November/December 2007
Vol. 26, No. 6

ABSTRACTS

Neonatal Mortality: A Critical Global Health Issue
Yolanda Ogbolu, MS, NNP

Almost all of the millions of babies who die worldwide in the first four weeks of life are in low- and middle-income countries. the socioeconomic status of developing countries adversely affects maternal-child health because it limits access to adequate nutrition, quality health care, medications, safe water, adequate sanitation, and other basic social services. The factors associated with high infant mortality rates transcend national boundaries, making infant mortality a critical global health problem. Poverty is one of the most important factors affecting the infant mortality rate in Nigeria. This examination of infant mortality in Nigeria exemplifies the multifactorial national and international issues underlying infant mortality in developing countries. infant mortality in these countries will not improve without global attention and intervention. By finding creative ways to share expert knowledge about caring for neonates, neonatal nurses can contribute to global improvements in maternal-child health care.

Poverty as Context for the Parenting Experience of Low-Income Lumbee Indian Mothers with a Medically Fragile Infant
Sharron L. Docherty, CPNP, PhD
Candace Lowry, BSN
Margaret Shandor Miles, RN, PhD, FAAN

Purpose: To explore the influence of poverty on the parenting experience and maternal developmental trajectory of Lumbee mothers with medically fragile infants.
Design: A multiple–case study design using secondary data from a larger longitudinal study of parental role attainment with medically fragile infants.
Sample: five cases involving mothers who were Lumbee Indians and who had medically fragile infants.
Results: The key features of the mothers’ talk about their parenting experiences were organized into categories that fit into five inductively derived themes related to poverty.
Implications: Health care professionals need to be aware of how the context of living in poverty affects mothers of high-risk infants who are hospitalized in tertiary care units. In particular, low-income mothers, especially American Indians living in high-poverty areas, urgently need improved community resources such as access to birth control; early prenatal care; programs to help reduce drug, alcohol, and tobacco use both during and following pregnancy; and follow-up health and developmental services for their infants.

Retinopathy of Prematurity: The Disease Process, Classifications, Screening, Treatment and Outcomes
Sallie Nash Harrell, RN, MSN, CNNP
Debra Huffman Brandon, RN, PhD

Retinopathy of prematurity (ROP) is the cessation of normal eye development and subsequent abnormal vessel growth that occurs exclusively in premature infants. ROP was first discovered in the 1940s and was for two decades the leading cause of blindness in children. Currently, the disease causes about 500 new cases of blindness per year. The severity of the disease increases with decreasing gestational age. The pathogenesis of ROP involves disruption of normal retinal vascularization. Vessel endothelial growth factor, insulin-like growth factor, and oxygen play important roles in its development. ROP is classified using an international classification system that provides direction for screening and treatment of premature infants. Examinations are performed by ophthalmologists, who identify the scope of vascularization, the degree of abnormal vessel growth, and the amount of the eye that is affected. Treatment modalities include cryosurgery and laser photocoagulation. Long-term outcomes include both structural and functional vision problems.

Peripheral Intravenous Extravasation: Nursing Procedure for Initial Treatment
Janet L. Thigpen, RNC, MN, CNNP

Tissue extravasation resulting from intravenous (IV) infiltration can occur as a complication of neonatal intensive care with varying degrees of morbidity. Serious extravasation can result in pain, infection, disfigurement, prolonged hospitalization, increased hospital costs, and possible litigation. Although most infiltrates resolve spontaneously after the IV catheter is removed, IV extravasations and tissue sloughing do occur in NICU patients. Specific therapies are based on assessment of the degree of the injury. The goal in managing tissue damage after IV extravasation is to improve tissue perfusion and prevent progression of tissue necrosis. This article presents an initial approach to nursing care for peripheral IV infiltrations to guide clinicians in management of this complication. The approach is based on clinical experience, descriptive studies, and reports from expert committees.